Investigator Background: Dr. Kukla holds a Ph.D. in clinical psychology from Purdue University (Indianapolis) and is currently a Research Scientist at the VA HSR&D CIEBP. Dr. Kukla has research experience and interest in psychiatric rehabilitation, and particularly, evidence based practices that improve functioning in adults with mental illness. Dr. Kukla's primary area of research interest is enhancing competitive work functioning in veterans with mental illness. Project Background: Veterans with mental illness are more likely to be unemployed than veterans without mental illness and persons in the general population. Consequently, these unemployed veterans often rely on government entitlements and suffer a range of deleterious outcomes. VA supported employment programs, which provide individualized vocational assistance, are partially effective in tackling this unemployment problem. Unfortunately, 40% of persons cannot find work even with this assistance and those who get jobs have difficulty keeping them, as the majority of people experience a job loss within 4 to 8 months. Past studies have linked self-defeating thoughts about one's ability to work and succeed on the job in persons with mental illness working in sheltered work. Cognitive behavioral therapy (CBT) has been demonstrated effective in improving other functional domains when combined with psychiatric rehabilitation approaches;however, no prior research has addressed whether CBT may be effectively adapted and applied to improve competitive employment outcomes in veterans with mental illness. Overall Goal: Dr. Kukla's overall goal for this CDA-2 is to acquire the skills and expertise necessary to become a productive independent VA researcher studying and implementing effective ways of enhancing vocational functioning in the community in veterans with mental illness. Specific Goals &Study Design: The proposed research aims to develop an effective and implementable CBT intervention tailored for competitive work functioning in veterans with mental illness. Training goals involve gaining expertise in qualitativ and mixed methods as well as implementation science. 1. Goal 1: Identify the barriers and facilitators to competitive work functioning in veterans with mental illness. The first project phae consists of online surveys and follow-up in-depth phone interviews of supported employment staff from VA medical centers around the country. This mixed methods approach will provide rich data that will help guide the revision and adaptation of the CBT program. 2. Goal 2: Adapt a cognitive behavioral therapy program aimed at improving competitive employment outcomes in veterans with mental illness. This second project phase consists of a formative evaluation used to tailor a CBT program to improve competitive work outcomes. First, the existing CBT intervention will be revised based on the results of staff interviews in Phase 1 and existing empirical literature. Next, two groups of veterans with mental illness will participate in and provide feedback on the 8-week group CBT intervention;the CBT intervention and treatment protocol will be revised after each wave of participants goes through the intervention. 3. Goal 3: Conduct a longitudinal pilot study using the newly adapted CBT program. To test the revised intervention and determine effect sizes in preparation for a large multi-site trial of the intervention, we will compare 25 participants who receive the CBT intervention and are engaged in supported employment services to a control group comprised of 25 participants engaged in supported employment services only. Primary outcomes will include competitive work outcomes (e.g., duration of employment);secondary outcomes will include psychosocial outcomes (e.g., quality of life, symptoms, psychiatric hospitalizations, work-related self-efficacy, work productivity, work effectiveness, veteran satisfaction).

Public Health Relevance

Unemployment and frequent job losses in veterans with mental illness are associated with serious personal consequences, in addition to negative economic outcomes, including more severe symptoms over time, higher service utilization (e.g., more frequent inpatient hospitalizations), and poor quality and quantity of social networks. Conversely, working extended periods of time in the community is linked with better psychosocial and quality of life outcomes, in addition to lower service utilization. The cognitive behavioral intervention proposed in this project seeks to improve competitive vocational functioning in the community, thereby bolstering veteran outcomes in these vital life domains. In addition, the proposed CBT intervention is aligned with federal priorities to assist veterans with disabilities to find meaninful work and achieve their career aspirations.